If you’ve ever had to visit an ER or doctor in another country, you know how critical it is to have an emergency medical card, and several supplemental documents, with you at all times (or at least in your hotel room). Some of this medical and personal information seems pointless to write down since you can reel it off the top of your head, but most of it isn’t — and you don’t want to be kicking yourself for not having the contact info you need when you’re ill or injured so far from home.

Your emergency medical card (or page, printout, etc.) and supplemental info should include your critical health and personal data, and definitely not be left to the last minute since it can take surprisingly long (as in, upwards of eight hours!) to gather and list all the information. Sound boring and tedious to put together? It is — but hopefully the following can help.

Your card should include the names, phone numbers, and addresses or email addresses for the following:

6. A list of your medications, including generic and brand names, reason for taking each, dosage information, and how often taken;

7. All medical conditions or allergies you have; and

8. Documentation of any immunizations required by the country you’re visiting.

Items to attach or keep with this card include:

1. A copy of your medical insurance card (keep the original in your wallet);

2. At least one insurance claim form (note that you shouldn’t have to navigate through the member services department of your HMO to get insurance claim forms; the travel clinic should carry them);

3. A signed letter from your physician describing your general medical condition(s), and all current medications;

4. The list of urgent care services and doctors that you have researched in each country (or, more likely, had your physician or travel agent research for you); and, if you’re traveling off the beaten tourist track:

5. The name of any medication conditions, and medications, written in the local languages of the areas you plan to visit. For translation services, try asking your travel clinic first since your main care practitioner may not know where to send you within your HMO or PPO. Note that it’s unwise to use a free online translation service since the software may misunderstand (or not understand at all) complex medical and technical terms and any abbreviations.

Keep the card and all supplemental documents somewhere where they won’t get wet or stolen (to be on the safe side, include one copy in your purse or smaller bag, and one in your checked luggage). Tell anyone traveling with you about the card and supplements, and their location(s).

While you’re busy compiling all this information, don’t forget to fill out the page inside your passport with the name, address, and telephone number of someone to be contacted in an emergency (you’d be amazed at how many people forget to do this).

Finally, before you go, be sure to register your destination countries, visit dates, and hotel addresses in your country’s traveler enrollment program. For Americans, this would be the U.S Embassy’s STEP (Smart Traveler Enrollment Program) system at https://step.state.gov/step/. If you do need urgent assistance from an embassy, STEP will already have your basic information on file.

As many of us can attest to, dozens of modern international airports are like mini-cities, complete with malls, chapels, huge kid’s play areas, two-story food plazas, and sometimes even golf courses and movie theaters. As travel services have evolved into an art, more and more airports have focused on offering the weary, anxious, or downright cranky traveler the chance to de-stress — to the point that some of us might even forget we’re in an airport. Spas? Art galleries? Gardens? They’re in many of the world’s largest and most popular hubs — maybe even in the one you call your own.

You don’t have to belong to an airline’s VIP club to access most of these relaxing amenities; you just have to find the right terminal. So, if you have a choice of where to spend a long layover on your next trip, I offer these observations about some of the best airports out there where you can settle your frazzled nerves instead of dreading the next bout of altitude. I’m sure you can think of a few other airports where you wouldn’t mind killing some time at all.

Kuala Lumpur International Airport, Malaysia

Rainforest

Reflexology and massage center

Narita International Airport, Tokyo

Silence room

Reflexology center

Oxygen bar

Dubai International Airport, United Arab Emirates

Two indoor Zen gardens, located on either end of the concourse

San Francisco International Airport

Yoga room

Library

Aquarium

Art galleries

Schiphol International, Amsterdam

Library

Museum

(No offense to Schiphol, but besides the library and museum, this has to be one of the noisiest, most hectic airports on earth… and this is after they ditched the one-terminal concept!)

Five themed gardens, one of them home to more than a thousand butterflies

Free calf-massage stations

Designated napping facilities

Vancouver International Airport

Sleep pods, complete with noise-canceling earphones

I can think of some airports I’d put on a different list for being the loudest, most irritating, panic attack-inducing places on earth, but alas, one of the best ways to manage stress is to keep things positive. So, I’ll leave you with this image — wherever you may be right now.

Too bad more of us don’t find laying over in Tallinn, Estonia convenient. The international airport, Lennart Meri Tallinn, has passenger relaxation at every gate down to an art.

Yes, a kit will take up quite a bit of room in your luggage, but you could save yourself a lot of stress and misery by having it along — especially if you’ll be traveling to a remote destination.

Many of us automatically buy prepackaged first aid kits and don’t check to make sure that it truly has everything that we need as travelers. The fact is, many first aid kits are packaged more for sports enthusiasts or in the case of on-the-job accidents. You can start out with one of those kits, but there will be things you need to add to it.

So here’s what belongs in your travel medical kit:

Bandaids of all sizes

gauze, and one stretch bandage

medical tape

an extra bottle of hand sanitizer (in addition to what you should be carrying around with you at all times)

antacid

anti–motion sickness medication, or ginger root

pain medication (of course)

a cold compress

insect repellant wipes

antifungal and antibacterial ointment

hydrocortisone cream

scissors

antidiarrheal medication (bismuth subsalicylate, loperamide)

a mild laxative

cotton balls

Optional:

lubricating eye drops

cough suppressant/expectorant

cough drops

antihistamine

Ziploc bags and Q-Tips

rubber gloves

What looks like “overkill” to be shoving in next to your toiletry bag could save your day abroad — or someone else’s.

I’ve asked a lot of travelers this question, and consistently noted that about half of people say yes, and about half say no. Jet lag is one of those things international travelers inevitably have to manage, and something that we either learn to put up with, ignore, or (at the very least) use as a good explanation for our coworkers, family, and friends after we get back from a trip and feel like we’re stumbling through a fourth dimension for a week.

Interestingly, those who admit that jet lag causes them quite a bit of anxiety discover that it’s actually worrying about jet lag that causes them the most stress (how will it affect them physically? Mentally? Emotionally?) while those that say jet lag doesn’t bother them often say that while jet lag is irritating, it relaxes them in a certain way — unlike any other physiological phenomenon. These are people who actually don’t mind having their natural body rhythms thrown off because it is a break from their daily rut of work-eat-sleep-worry-work-eat-sleep-rinse-and-repeat. In other words, jet lag is just a feature of being on vacation, of doing something different.

Given the varying reactions and all the anecdotes and quick-fix recommendations that abound out there on how to deal with jet lag, it’s worth taking a closer look.

Jet lag results from alterations to the body’s circadian rhythms caused by trans-meridian (west–east, or east-west) air travel. When traveling across a number of time zones, your body’s natural pattern is upset as the cycles that govern times for sleeping, eating, and body temperature regulation no longer correspond to your environment. To the extent that your body cannot immediately realign these rhythms, you are “jet lagged.” Symptoms can either aggravate anxiety, or be mistaken for intensified side effects of medications. Some of the most common jet lag symptoms include:

Jet lag usually occurs with a change of three time zones or more, and the extent to which you’re affected depends on the number of time zones crossed. If you’re unfamiliar with jet lag (or just want to explain it as painlessly as possible to your great-aunt), it’s worth noting that the maximum possible disruption is plus or minus twelve hours. If the time difference between two locations is greater than twelve hours, subtract that number from 24 to understand the “adjusted” time zone difference. New Zealand, for example, being nineteen hours ahead of Pacific Standard Time, would pose only a five-hour jet lag challenge to a traveler from California.

The recovery time for jet leg is generally one day per time zone crossed, although many people (particularly those who travel more) are able to recover faster. Women are affected by jet lag more than men, since normal nighttime and daytime body rhythms are connected to estrogen levels. Recovery will also depend on whether your flight(s) are overnight or scheduled during the day. You’ll typically experience more jet lag if you begin a long flight mid-morning or early afternoon than if you take a “red eye” flight departing at eight p.m. or later (it helps, of course, if you can actually fall asleep on an airplane).

Unfortunately, there are no proven ways to avoid jet lag altogether. You can talk to your general care practitioner about where specifically you’re going, and how to strategize flight times and sleep hours, to try to minimize the impacts. Your doctor may suggest getting only a minimal amount of sleep the night before your flight (so that you’re naturally sleepy when you arrive at your destination) or taking a prescription-strength sleep medication for the first several nights of your trip.

We’ve covered how to manage detours, crowds, and making eye contact with so many strangers. What else can make you wig out on a vacation, and what can you do about it?

Accidents. Seeing an accident while touring – whether it involves a slip, trip, fall, or a vehicle – can jar your confidence and make you feel like you’re next to have disaster descend upon you. Depending on how much you can relate to the person who suffered the accident, and just how bad it was, you may put sudden limits on your physical activities or transportation that can rapidly develop into a phobia. There are some things to understand about accidents before your healthy precautions build into a cage of fear.

I once saw a middle-aged tourist do a full somersault down the departures escalator at London’s Heathrow Airport. He was distracted by writing on the luggage tag of his carry-on bag, and lost his balance as the escalator belt hit a bump followed by a small jerk. The next thing the man knew he’d flipped upside down, and then lay dazed on his tailbone on the bottom step.

Interestingly, about half the people at the scene (the ones who hadn’t seen him writing up his luggage tag, completely oblivious to his surroundings) were shocked and horrified; the others (who’d seen what the man had been doing) had a look on their faces like, “Well, what did he expect?”

The point is that most of the accidents you see or hear about – perhaps of a taxi driver backing into a tourist, or of someone twisting their ankle between cobblestones – are not true “accidents,” but mistakes. An accident implies that nothing could be done to prevent the incident from happening, when really a lot could be done in most cases – if people were paying attention and taking the proper precautions. Once you realize this, and understand that it takes two people, places, or things to have an “accident,” the less anxiety you will suffer. Instead of blaming an elevator or a door or a moving vehicle, you recognize that by being vigilant you not only make up for hazards and for other people’s carelessness, but you give yourself a lot more control over your surroundings.

Perceived sounds of distress. Anxious people have often experienced a significant trauma in their past. Certain noises, particularly screaming and shrieking, can cause you great alarm and induce sweating, heart palpitations, and other physiological manifestations. If you suffer from this phobia, screaming is not an expression of a good time, but a sign of an emergency. Screaming children at play can make you think someone is hurt, and I know several women who are haunted by images of sexual assault when they hear teenage girls screaming.

To keep your reaction from escalating, take a quick look at what screaming children or teenagers are doing, and observe other people’s reactions to them. If there was really something wrong, wouldn’t others notice and step in to help?

In general, someone else’s noise rarely has anything to do with you. If it’s still a significant anxiety trigger, try to stay away from amusement parks, carnivals, and other places where you’re most likely to hear excitement bordering on terror.

Avoiding confrontation when taking photographs.If you’re a visual person and want to relive many moments of your trip, then taking pictures will be one of the most rewarding and essential parts of your journey. Unfortunately, it’s the one thing you do in the normal course of touring that can cause some provocation – usually because people are concerned that they’ve appeared in your photo (or video footage). In general, the more elaborate your camera is, the more attention you’re going to attract using it. Snapping shots with your cell phone is going to draw the least attention; setting up a tripod with a camera the size of your head will attract a lot more; and walking around with a videocamera constantly raised and pointing will attract the most.

You may be aware of all of this, and have reluctantly resolved to hold back your shutterbug impulses. However, there’s no need to restrict yourself like this, and later regret what you didn’t get on film. Here are some tips to avoid confrontation and ease anxiety when out and about with a camera.

Portray clear intentions.If you want to photograph a famous landmark and there are people constantly milling around, look directly at what you’re shooting and don’t make eye contact with the people around it. This will reassure others that you’re not interested in them or in invading their privacy.

If someone confronts you about whether you’ve taken a picture of them, or included them in your shot or video footage, offer to erase the photo. In almost every case they won’t actually take you up on this; they just want some reassurance that you’re a tourist and not a voyeur. If they do take you up on it, then wait until they’re out of the picture, so to speak, and re-shoot. It’s a lot faster than arguing with someone and getting yourself significantly distressed.

Watch what others are doing. If there are signs or graphics around a place indicating that photography isn’t allowed, take a look at whether others are shooting photos anyway. I have been in museums or churches that officially ban photography (and state so right on the front door), yet people were taking pictures left and right and no one stopped them. If you want the same picture everyone else is taking, then take it. The worst that can happen is that a grounds person comes by and chastises the whole lot of you.

The opposite can hold true for military buildings and embassies. Military buildings can be surprisingly difficult to recognize, and it’s usually understood that absolutely no pictures can be taken even if there are no signs indicating such. Embassy districts are usually filled with attractive buildings and landscapes that make for great picture opportunities, but keep in mind that they often prohibit photography as well.

In poor areas where local or indigenous people depend heavily on tourists for economic survival, check to see if you’re expected to pay to take a photograph (of a person, place, or item). Save yourself embarrassment and stress by abiding by the rules.

Imagine my embarrassment when I stopped to take a quick picture of these cool port-o-potties in Moscow, then thought in horror that the woman to the left forgot to close the door for herself (she was just the babuskha collecting the rubles)

Part of the fun of traveling is getting to explore the unknown. Unfortunately, the delight of discovering something new and different can sometimes come with significant distractions and aggravations. Addressing and managing several of the most pervasive “travel anxiety triggers” is easily possible, and will help you get back to enjoying your trip.

Detours. The more you travel, the more you’ll realize that the world is an unfinished work of art. The average metropolis can have at least half a dozen construction projects shaking the ground at once, while a mega-city can have a dozen or more. Popular tourist destinations become even more popular and congested when they win a bid to host a major sporting event, or cultural or political summit; new coliseums, arenas, hotels, and rail tracks suddenly spring from the dirt, outdating your map and giving you a new challenge in the form of blocks-long rows of pylons and yellow tape. Although construction detours are the most common you will find, you might also encounter detours to accommodate marches, protests, security lockdowns for government officials, biking and marathon events, and others.

Unfortunately, pedestrian detours can lead to confusion, disorientation, and getting very, very lost if you don’t know how to handle them. Your stress level is going to shoot sky-high if you “follow the orange signs” only to find yourself in an alley at dusk with no idea which direction to turn. Here are some useful guidelines for managing detours.

Trust the logic of the detour. City planners and engineers have to get a number of high-level approvals to implement one, and while not all detours are intuitive, the basic goal is to get you as close as possible back to where you need to be, in the shortest amount of time. You may have to let go of your initial assessment of where you should be, and go with the flow of a detour even if it feels like you’re going the wrong way. As any construction worker would tell you, there’s a reason why two U-turns gets you headed in the right direction again.

Before you go through the detour, clearly understand where you are by picking a landmark that you can identify from blocks away (i.e., at the end of the detour). This is essential if you need to retrace your steps, but the detour only allows foot traffic one way (this usually occurs with detours from a train or metro station).

If you have no idea where you’ve ended up at the end of the detour, see where the majority of other people (especially commuters) are going, and follow them. Tourist areas in most cities back right up to central business districts. If you still can’t find the tourist area or where you want to go, and it’s too stressful to ask a stranger, then head back to the detour exit and try another direction. Improvising after you’ve followed a bunch of people two blocks down the road is not a good idea.

Recognize that detours can take you up or down as well as north, west, east, or south. You may have to take stairs, tunnels, or escalators to avoid a construction zone. If you think only in terms of traveling across, you could find yourself staring at a dirty wall.

Crowds. There’s nothing like a throng of humanity crammed into a small plaza or a narrow street to aggravate even the most extroverted people. Anxiety triggers include noise, getting jostled around, fear of pickpockets and other thieves, and feelings of constant self-consciousness.

The key to dispelling anxiety about crowds is to understand that they’re made up of smaller units of people. In social settings, people rarely interact in groups larger than six or seven, and are so tuned in to each other that they won’t even notice you. Except at private functions, each group knows very little about anyone outside their group. And each group can look cliquish simply because they’re a little uncomfortable about all the strangers around them.

As a tourist, managing a crowd (i.e., bunches of groups) is usually a matter of either getting around it, or through it. Groups in dining halls, plazas, or other confined settings can be the most challenging given the potential to get “stuck” for space between one group and another. You’ll find that walking the perimeter of a gathering area can be less stressful as you reduce the number of times you have to break “through” people, and are simply going around them.

Crowds in line are often less intimidating. People will pay attention to you at the beginning, for long enough to see if you’re going to cut in front of them; otherwise, their attention will be diverted to how fast they’re moving forward.

A third type of crowd gathers to fill a theater, stadium, or other event venue; their focus is on what’s happening in front of them, not on you. Take a look around the rows and you’ll see that people are too absorbed to watch you. If you still feel considerable anxiety being part of an audience, then sit in the back (or towards the top) where you won’t feel so many pairs of eyes staring at the back of your head.

Eye contact. One of the most unnerving things for those of us who are shy, sensitive, and/or anxious is to pass, see, or be passed by hundreds or even thousands of strangers every day – many of whom, for whatever reason, want you to look back at them. Stressful emotions that arise from unwanted eye contact include feelings of intimidation from being stared down; intense self-consciousness from people who sneer for no good reason; uneasiness from sexually suggestive ogling or once-overs; and the glares or grimaces of angry or sad people. People carry a tremendous amount of emotional energy in their gaze, and making eye contact with every single person you come near could be so draining that you’re distracted from sightseeing.

One of the reasons people think they need to make eye contact is to avoid bumping into others. The truth is, you don’t have to make eye contact in order to navigate sidewalks, shops, squares, and tourist attractions; if you look in the direction you want to go, then people will not bump into you. Even if you have sunglasses on people will generally be able to tell by your body language what direction you plan to steer, since both your body and attention tilt slightly (but perceptibly) depending on what you’re focusing on. You can make a similar evaluation of others by doing a split-second assessment of their focus and movements.

Is avoiding eye contact a way of giving into (or developing) a phobia? Given the number of cultures that discourage direct eye contact between people on the street – and particularly between the opposite sex – it would be difficult to say yes. Save the emotional energy it takes to make eye contact for the people who matter more – hotel staff, store clerks, and others who are helping you have a pleasant journey.

Just the idea of bumping right into strangers in crowded areas can stress people out. In Japan, the authorities don’t want to see you embarrassed (or bruised), and post “warning” signs that you might not see elsewhere.

One of the first things someone might ask when you announce your trip to another country is, “Do you know the language?” Unless you’re visiting an ancestral homeland, are a language buff, or have learned foreign language(s) for your job or personal reasons, the answer will likely be no. You may stress out over the thought of being unable to make your way around or communicate your needs during your trip. The more this anxiety builds, the more pressure you could put on yourself to spend many hours learning a language – including nuances that you’re unlikely to need.
Unless you’re planning to spend an extended amount of time in a country, knowing the hundred or so “quick reference” words and phrases in a standard travel language book will usually be sufficient to get you around. Focus on language concerning transportation, directions, obtaining assistance, and health and safety issues (such as the words for danger, caution, and hospital, as well as how to ask for an embassy or the police). If this still doesn’t sound like enough, remember that there’s a reason that so many travel language books are sized to fit in your pocket. You can look up phrases and words as you need them, without putting yourself through painful memorization exercises weeks before your trip.Do You Speak English?
This is an essential phrase to know in every language spoken in the places you’re visiting. It manages your limited language skills while showing that you’re culturally sensitive enough to not just assume that someone speaks your language; it also helps break the ice. If the person confirms that they speak English, then you’ve started off on the right foot; if they say no, then nod or apologize (think of how you feel when you dial the wrong phone number) and move on to someone else. If you can’t move on to someone else, see how far you can get with numbers and gestures. If you’re still struggling, then other employees or passersby are likely to notice, and chances are one of them will step in to help – if for no other reason than to show off their command of English.

A word of caution: if you have a rudimentary grasp of a foreign language and ask for directions or check into a hotel in that language, you need to be able to understand the person’s response. The person might answer at a mile a minute, and you’ll either pretend to understand and move on, or ask for clarification in English – at which time the person will wonder (with some frustration) why you didn’t ask in English in the first place. If you’re not proficient enough to go back and forth in conversation on a particular topic, then it’s usually best to ask Do you speak English? and go from there.

Should I cross the street, or stay put and look out for the cute marshmallow doughboy?

Most of us don’t get beyond learning a few written characters when touring places like Japan or China